Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | TA0126 | MS |
NPI | 1023321254 |
---|---|
Provider Name | Georgianna Tappa |
First Address | Durant, MS 39063-3009 |
Second Address | Vaiden, MS 39176-5385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2010 |
Last Update Date | 16/07/2010 |